Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Vaccine. 2018 Nov 26;36(49):7562-7567. doi: 10.1016/j.vaccine.2018.10.065. Epub 2018 Oct 24.
Persistent Human Papilloma Virus (HPV) infection is associated with the development of cervical cancer, a leading cause of female death worldwide. In Lebanon, cervical cancer is the 6th most common cancer amongst girls and women aged 14-44 years. Cervical cancer is preventable through HPV vaccination; however, Lebanon does not include HPV vaccination in its national routine vaccination schedule. Hence, physician recommendation is key for patient vaccine uptake. We conducted a cross-sectional study in Beirut, Lebanon to assess factors affecting physician recommendation regarding HPV vaccination. Physicians practicing in Obstetrics and Gynecology (OBGYN), Pediatrics, Family Medicine and Infectious Diseases were included in the study. In total, 228 physicians completed the survey (28.79% response rate). The survey consisted of a set of demographic and HPV knowledge questions along with clinical vignettes. The vignettes presented theoretical patients who differed in gender, age, sexual activity, social background and whether the patient presented with his mother or not. The results show that physicians tend to recommend the vaccine more commonly for vignettes presenting female patients, with an Adjusted Odds Ratio (AOR) of 6.8. Also, physicians were more likely to recommend the vaccine for vignettes with patients coming from a non-conservative background (AOR = 2.1), vignettes where patients claim to be sexually active (AOR = 2.7) and vignettes where patients presented with their mother (AOR = 1.4). Physicians tend to recommend the vaccine less in vignettes with married patients (AOR = 0.5). Physicians with higher knowledge scores recommended the vaccine more often (AOR = 3.4). Overall, OBGYN physicians recommended the vaccine less than pediatricians (AOR = 0.5). These results show that Lebanese physicians' recommendations rely on factors external to international guidelines. The results also highlight the importance of knowledge in adequate patient consultation. Thus, improved physician awareness towards international guidelines and physician education regarding HPV vaccination is essential in order to improve patient care in Lebanon.
持续性人乳头瘤病毒（HPV）感染与宫颈癌的发展有关，宫颈癌是全球女性死亡的主要原因。在黎巴嫩，宫颈癌是 14-44 岁女孩和妇女中第六常见的癌症。HPV 疫苗接种可预防宫颈癌；然而，黎巴嫩并未将 HPV 疫苗接种纳入国家常规疫苗接种计划。因此，医生的建议对于患者接种疫苗至关重要。我们在黎巴嫩贝鲁特进行了一项横断面研究，以评估影响医生推荐 HPV 疫苗接种的因素。参与研究的医生分别从事妇产科、儿科、家庭医学和传染病学专业。共有 228 名医生完成了这项调查（28.79%的回复率）。该调查包括一套人口统计学和 HPV 知识问题以及临床病例。病例介绍了在性别、年龄、性行为、社会背景以及患者是否与母亲一起就诊方面存在差异的理论患者。结果表明，医生更倾向于为女性患者推荐疫苗，调整后的优势比（AOR）为 6.8。此外，医生更有可能为来自非保守背景的患者（AOR=2.1）、声称自己有性行为的患者（AOR=2.7）和与母亲一起就诊的患者（AOR=1.4）推荐疫苗。对于已婚患者（AOR=0.5），医生推荐疫苗的可能性较小。知识得分较高的医生更经常推荐疫苗（AOR=3.4）。总体而言，妇产科医生推荐疫苗的可能性小于儿科医生（AOR=0.5）。这些结果表明，黎巴嫩医生的建议依赖于国际指南以外的因素。结果还强调了在适当的患者咨询中知识的重要性。因此，提高医生对国际指南的认识以及对 HPV 疫苗接种的医生教育，对于改善黎巴嫩的患者护理至关重要。
